IN The Conversation earlier this year, Tim Baker described consultations with his oncologist: a distressing hour in the waiting room, and then the brief (ten minutes) and cursory consultation. Reading it was upsetting. I wanted him to have had the experience of an authentically engaged and caring clinical interaction. As Baker himself puts it: “The lack of opportunity for a more wide-ranging conversation … just feels wrong.”
I suspect if asked, most doctors would agree that empathy is important. However, we are also confident that the near $200 000 spent on empathy training for the previous Prime Minister, Scott Morrison, didn’t hit the spot. So perhaps the theory is easier to articulate than to put into practice. For me as a medical educator, two questions arise:
After years of involvement in medical education, I think the best outline of how empathy can be taught lies in the work by colleagues at the Māori Indigenous Health Institute (MIHI) at the University of Otago in Christchurch. They describe a framework to enhance the doctor–patient relationship with Māori. For this Hui Process, they draw “on traditional knowledge and practice [to align] it to a contemporary situation”. The principles are:
Many years ago, I remember being faintly shocked at hearing the late Professor Ann Woolcock talk about her children with her patient – something she would never do with me, a laboratory technician at the time. I think what Baker (and so many others) hanker for is that sense of connection that Professor Woolcock, a respiratory physician, understood could come from sharing her story of parental experience.
These acts are not simply to be “nice”. Lacey and colleagues (2011) based their framework on traditional engagement within Māori cultural protocols, and it specifically requires some self-disclosure by the clinician about their own experiences. This is not to burden the patient with the woes of the treating clinician, but to share some small personal relevant matter that goes some way to reducing the power differences in the consultation. Whānau is the extended family or community of related families, although it is a more subtle and complex network of relationships and responsibilities. And “It is emphasised that whakawhānaungatanga is not a one off event and there is a need to attend to connecting with the patient and whānau throughout the consultation”.
If it is necessary to sustain the effort of connection throughout the consultation, Baker’s oncologist makes no effort at connection at all. The encounters strike his patient as short and “perfunctory. … More than anything, I’d like a bit more evidence that he cares”.
Baker’s oncologist has “a waiting room full of patients and is already running an hour behind schedule” and “he’s seeing dozens of patients every day at roughly ten-minute intervals”. In my experience it takes time and energy, to engage, to disclose, to listen, to pay heed, to care.
So, we will need to teach that engaging and caring takes time. Ten minutes won’t cut it.
Having taught it, included it in the curriculum, designed the resources, delivered the teaching – now to assessment. Are there objective measures for this? Do we need to use proxy measures? Should we set essays (oh, the marking!)?
I think the assessment of empathy is best done by the those receiving it. I haven’t broached a discussion of the definition of empathy here -- because patients know. Every patient, Mr Baker, or anyone in any waiting room, or reading this article will know and intuitively assess the empathy of the clinician at their next consultation. Forget the multiple choice, “single-best-answer” questions. Forget the simulations. Let’s ask the people who will know best and who won’t be conned by smarm: the people we deliver care to. Let’s ask our patients and their families.
Dr Lilon Bandler is a Sydney-based GP, medical educator, and Associate Professor with the Leaders in Indigenous Medical Education Network at the University of Melbourne. She is Medical Director of health services at the Wayside Chapel.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
I suspect if asked, most doctors would agree that empathy is important. However, we are also confident that the near $200 000 spent on empathy training for the previous Prime Minister, Scott Morrison, didn’t hit the spot. So perhaps the theory is easier to articulate than to put into practice. For me as a medical educator, two questions arise:
- What is and how do we teach empathy?
- How should (could) we assess empathy?
After years of involvement in medical education, I think the best outline of how empathy can be taught lies in the work by colleagues at the Māori Indigenous Health Institute (MIHI) at the University of Otago in Christchurch. They describe a framework to enhance the doctor–patient relationship with Māori. For this Hui Process, they draw “on traditional knowledge and practice [to align] it to a contemporary situation”. The principles are:
- Mihi: greeting and engagement;
- Whakawhānaungatanga: making the connection;
- Kaupapa: attending to the main purpose of the encounter; and
- Poroporoaki: concluding the encounter.
Many years ago, I remember being faintly shocked at hearing the late Professor Ann Woolcock talk about her children with her patient – something she would never do with me, a laboratory technician at the time. I think what Baker (and so many others) hanker for is that sense of connection that Professor Woolcock, a respiratory physician, understood could come from sharing her story of parental experience.
These acts are not simply to be “nice”. Lacey and colleagues (2011) based their framework on traditional engagement within Māori cultural protocols, and it specifically requires some self-disclosure by the clinician about their own experiences. This is not to burden the patient with the woes of the treating clinician, but to share some small personal relevant matter that goes some way to reducing the power differences in the consultation. Whānau is the extended family or community of related families, although it is a more subtle and complex network of relationships and responsibilities. And “It is emphasised that whakawhānaungatanga is not a one off event and there is a need to attend to connecting with the patient and whānau throughout the consultation”.
If it is necessary to sustain the effort of connection throughout the consultation, Baker’s oncologist makes no effort at connection at all. The encounters strike his patient as short and “perfunctory. … More than anything, I’d like a bit more evidence that he cares”.
Baker’s oncologist has “a waiting room full of patients and is already running an hour behind schedule” and “he’s seeing dozens of patients every day at roughly ten-minute intervals”. In my experience it takes time and energy, to engage, to disclose, to listen, to pay heed, to care.
So, we will need to teach that engaging and caring takes time. Ten minutes won’t cut it.
Having taught it, included it in the curriculum, designed the resources, delivered the teaching – now to assessment. Are there objective measures for this? Do we need to use proxy measures? Should we set essays (oh, the marking!)?
I think the assessment of empathy is best done by the those receiving it. I haven’t broached a discussion of the definition of empathy here -- because patients know. Every patient, Mr Baker, or anyone in any waiting room, or reading this article will know and intuitively assess the empathy of the clinician at their next consultation. Forget the multiple choice, “single-best-answer” questions. Forget the simulations. Let’s ask the people who will know best and who won’t be conned by smarm: the people we deliver care to. Let’s ask our patients and their families.
Dr Lilon Bandler is a Sydney-based GP, medical educator, and Associate Professor with the Leaders in Indigenous Medical Education Network at the University of Melbourne. She is Medical Director of health services at the Wayside Chapel.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
Loading comments…
More from this week
InSight+ updates
29 April 2026
InSight+ reimagined: medical news and commentary redesigned with clinicians in mind
Disability
27 April 2026
Tightened eligibility and cuts to plans: what the NDIS changes mean for participants
Child health
27 April 2026
Childhood BMI changes genetically linked to adulthood diabetes and heart disease
Neurology
27 April 2026
Functional neurological disorder in Australia: disabling, stigmatised, and under-served
Sexual health
27 April 2026
Why GPs should be on the lookout for syphilis
Newsletters
Subscribe to the InSight+ newsletter
Immediate and free access to the latest articles
No spam, you can unsubscribe anytime you want.
By providing your information, you agree to our Access Terms and our Privacy Policy. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.